Introduction
As a resident or fellow, getting experience in a new surgical field
can be challenging. That’s why the 1st Annual Pediatric Orthopedic
Surgical Techniques Lab (POST) in Memphis, Tennessee, was
created — a course for senior residents and fellows who are looking
to branch out into or have an interest in pediatric orthopedic
surgery — the first one of its kind.
For residents, fellows and young attending surgeons, hands-on,
interactive learning is valuable. It is also a widely held belief that
training on cadavers is beneficial for the teaching of surgical and
operative skills, letting participants practice their skills in a safe
environment. In this course, the learning environment is enhanced
by world-class faculty who guide and mentor them. The POST
Course was designed to meet the needs of the developing pediatric
surgeon by combining cadaveric training, excellent bio-lab facilities
and expert faculty at the Medical Education and Research Institute,
to create a truly unique learning experience that focused on onlabel use of instrumentation and surgical techniques. The course
variety included:
• a series of short expert lectures presenting the rationale
behind the techniques to be practiced in the subsequent
lab
• a round of open discussion
• up to 10 hours of intensive, hands-on surgical lab guided
by the faculty members.

With a low ratio of four participants to one expert surgeon —
plus two specialist pediatric surgeons offering input to surgical
techniques at the same time — participants were able to delve
deep into learning. For upper and lower limb surgery, the labs
were set up to allow for simultaneous bilateral procedures, thus
four surgeons could work in parallel pairs, maximizing the time
spent in the lab. Students were able to log 10+ hours of practical
surgical training and, with lectures, up to 16.0 AMA PRA Category
1 CreditsTM.
Dr. Todd Milbrandt (Mayo Clinic) and Dr. Jeffrey Sawyer (Campbell
Clinic), leading experts in the field of pediatric orthopedic surgery,
co-chaired the event and carefully hand-selected a group of
expert faculty who are passionate about educating surgeons in
this specialty. In a collegial atmosphere, the faculty drew on their
personal experiences to provide participants with real-life tips and
tricks. There are only so many things that you can learn in a text
book, and only so many things you can learn through observation,
but being at the forefront and gaining directed hands-on
experience is a once-in-a-lifetime opportunity.
As one attendee said:

“I had three operations on my
bucket list, and I got to do all
three of them today.”

1

Upper Extremity and Trauma
Closed reductions and casting
Participants started Day 1 learning from Dr. Kelly about closed
reduction techniques and the importance of good casting, and tips
for gaining experience in the removal of casts in order to avoid
common cast burns and unnecessary cuts.
Tips from the faculty:
• Use casting simulators using sensors and saw bones for
pressure monitoring
• Keep good and bad casts as examples
• Have someone hold the limb correctly
• Run casting workshops
• Give constructive feedback
• Attend casting workshops
• Use a pool-noodle to practice cutting off a cast
Later in the program, participants acquired critical experience in
casting and removal during the clubfoot casting workshop, in which
some participants were able to use a cast saw for the very first time.

“We are never done learning, and
we are always teaching.”
— Dr. Kelly .

Derek Kelly, MD
Associate Professor, The University of Tennessee Health Science
Center
UT-Campbell Clinic, Department of Orthopedic Surgery
Dr. Kelly gained his degree in medicine from the University
of Arkansas (2002), where he also went on to complete his
residency. After a fellowship in pediatric orthopedics and
scoliosis at the Texas Scottish Rite Hospital for Children in
Dallas, he joined the staff of the Campbell Clinic (2008).
Dr. Kelly specializes in pediatric orthopedic conditions and
has a particular focus of Perthes Disease, being a member of
the International Perthes Study Group.

2

Christine Ho, MD
Staff Hand Surgeon, Texas Scottish Rite Hospital for Children, TX
Dr. Ho studied medicine at the University of Texas
Southwestern Medical School and completed an orthopedic
residency at the University of Southern California,
Department of Orthopedic Surgery. Dr. Ho completed her
fellowships in pediatric orthopedics and scoliosis, and pediatric
hand surgery, at the Texas Scottish Rite Hospital for Children.

Supracondylar humerus fractures
“This course isn’t just about traditional didactic learning, it’s about
teaching the practicalities of orthopedic surgery, such as OR setup,” Dr. Ho told participants, and that’s just what they received.
Some highlights and tips from Dr. Ho’s presentation:
• An optimized operating room set-up allowing for accurate
radiographs, increased access to the affected structures
and better visualization
• Using a short plexiglass board instead of a long hand-table
allows for better access to the elbow in a pediatric patient
• In difficult closed reductions, the joystick technique
technique using a 2.0mm smooth k-wire may be useful to
assist in fragment reduction
• Knowing when to perform an open reduction, particularly
in flexion-type fractures
• The rare occurrence of the easily missed transphyseal
fractures in toddlers, the difficulties in diagnosis and its
association with non-accidental trauma
Participants also gained insight into maintaining proactive, open
communication with the patient’s family.

1ST ANNUAL PEDIATRIC ORTHOPEDIC SURGICAL TECHNIQUES LAB

“We seldom have the chance to gain hands-on
experience - we watch demonstrations, watch videos
and read books, but here we can really practice the
techniques we have learned.” — A participant

Medial epicondyle fractures
Dr. Edmonds followed with medial epicondyle fractures,
demonstrating the need for a distal humerus axial radiograph to
evaluate anterior displacement.
“There are no reasons not to operate, even if closed reduction is
effective,” surgeons were told, along with insight gleaned from
Dr. Edmonds’ years of practice: the preference towards open
reduction comes from seeing muscle-function deficits left by closed
reduction, even when range of motion is restored.

Lateral epicondyle fractures
Dr. Ritzman delved into the particular importance of imaging,
giving participants the decision-making tools they’ll need to avoid
inappropriate closed treatment or inadequate fixation. Pediatric
orthopedic surgeons need to be ready and prepared to operate
and pin if necessary. Dr. Ritzman presented recommendations for
use of divergent pins and a washer to bring these points home in a
practical way.

Distal humerus axial view to evaluate anterior displacement

Todd Ritzman, MD
Pediatric Orthopedic Surgeon,
Akron Children’s Hospital, Akron, OH
Dr. Ritzman graduated from the Ohio State University College of Medicine
before completing his residency in orthopedic surgery at the Cleveland Clinic.
He completed a fellowship in pediatric orthopedics and scoliosis at the San
Diego Children’s Hospital, before moving to the Akron Children’s Hospital.

Obtaining internal oblique radiographs, which show
displacement 70% of the time, is critical to diagnosis.
— Dr. Ritzman

3

Forearm fractures
After reviewing standard techniques for using pins, plates and
screws or intramedullary nails for forearm fractures, Dr. Ho
covered the use of curved flexible nails.
Tips for placing flexible nails:
• Drill an opening hole 1 mm larger than the nail
• The starting point is always a little more dorsal than you
think at first
• Be ready to attempt an open reduction if closed passage of
a nail fails after three or four attempts
• Consider burying pins
• Fix the ulna first then the radius

“There are so many surgeons and
so few participants - we can ask
them anything we want, they are so
approachable.”
— A participant

Lab session

Participants had the opportunity to see a selection of real-life
cases, reinforcing the principles of fracture healing they’d learned
— particularly demonstrated by the 6-month outcomes, which
demonstrated the astounding remodeling capabilities of pediatric
bone.

The washer can be clearly seen on this X-ray showing lateral
condyle pinning

Over the course of 3 hours, participants were able to get handson experience with supracondylar pinning with a blind medial
pin followed by an open approach, supracondylar ORIF with
an anterior approach, lateral condyle approach and pinning
versus screw fixation, medial epicondyle reduction, and pinning
and nailing of the forearm. At all 8 lab stations, the participants
were able to work bilaterally in simultaneous pairs, under the
supervision of the expert faculty. This provided an opportunity to
assess the differences between techniques, to observe hardware
placement on fluoroscopy, and to receive immediate, constructive
and corrective feedback. At Dr. Ho’s station, participants were
actively encouraged to question their instrument choices, were
asked to check the fluoroscopy themselves and give their opinions,
and were made aware of feeling the differences between two
different techniques. Dr. Ho gave her input into their choices
and assessments, and commented “I know all this, I have done it
all before” reinforcing how her expert experience can help the
participants learn.

Eric Edmonds, MD
Assistant Clinical Professor, University of California, San Diego, CA
Pediatric Orthopedic Surgeon, Pediatric Orthopedic & Scoliosis Center,
Rady Children’s Hospital, San Diego, CA
Sports Medicine Program Consultant, Rady Children’s Hospital, San
Diego, CA
Dr. Edmonds qualified from the University of California Davis School of Medicine
(2002), completed his residency in orthopedic surgery in the Carolinas Medical Center
in Charlotte, NC, was a Pediatric Orthopedic and Scoliosis Fellow at the Rady Children’s
Hospital in San Diego and, in 2008, successfully completed a travelling mini-fellowship in
Sports Medicine, which took him to Boston, Philadelphia and back to San Diego. Clinical and
research interests:
• Youth sports medicine
• Musculoskeletal trauma
• Outcome studies for athletic shoulder, knee and ankle injuries
• Outcome studies for fracture treatment

4

1ST ANNUAL PEDIATRIC ORTHOPEDIC SURGICAL TECHNIQUES LAB

Hip and Lower Extremity Infection and Trauma
Septic hip arthrotomy
Dr. Frick instructed participants on how to correctly diagnose
septic hip and the need for arthrotomy, and in the use of a systemsbased treatment approach. Some of the tips participants learned:
• The only treatment for treating a pediatric patient with
“pus under pressure” is to operate
• It is essential to perform a clinical examination of the
patient, regardless of the hour, to avoid increased
morbidity through incorrect treatment of a missed septic
hip
• An MRI scan is essential before operating
• Systems should be set up between orthopedic surgeons
and the radiology department, to enable rapid access to
MRI scans

“In 15–20% of the
time, the MRI scan
alters the treatment
plan.” — Dr. Frick

Dr. Frick also warned that participants should be wary of leukemia
in septic hip particularly in the presence of low hemoglobin.

Femoral fractures
The main take-away message Dr. Novais gave participants was the
importance of using the correct implants for the right fracture,
particularly in diaphyseal fractures — a point he stressed with
a clinical case presentation. Participants further learned about
treatment algorithms in femoral neck fractures, with early surgical
intervention being the best prevention against osteonecrosis of the
femoral head.

Consultant, Nemours Children’s Hospital Muscular Dystrophy Association
Clinic, Orlando, FL.
Dr. Frick graduated with a medical degree from the Medical
University of South Carolina (1991) and went on to complete a
fellowship in orthopedic research and residency in orthopedic
surgery at the Carolinas Medical Center in North Carolina. Dr. Frick
also completed a fellowship in pediatric orthopedics at the Children’s
Hospital San Diego and University of California, San Diego.

Fixation techniques in tibia fractures
The goal of different fixation techniques for tibial fractures is
achieving bone-healing, weight-bearing and acceptable alignment.
Dr. Iobst presented the technique of cast-wedging as an alternative
to hardware for achieving fracture reduction. Participants also got
insights into the benefits of external fixators and hexapod frames,
especially when there is an open wound, sparking discussion on
the acceptable age for a locking proximal nail and the possibility of
growth arrest through disruption of the physis. Members of the
faculty shared their different age cut-off points and considerations,
based on their personal experiences.

a

b

c

Eduardo Novais, MD
Orthopedic Surgeon, Orthopedic Center and
Children and Young Adult Hip Preservation
Program, Boston Children’s Hospital, Boston, MA
Dr. Novais gained his degree in medicine in Brazil at the Universidade
Federal de Minas Gerais (1999), where he also completed his
residency in orthopedic surgery. He went on to a number of
fellowships, primarily in pediatric orthopedics in both Brazil and at
the Campbell Clinic in Memphis, TN, and the University of Utah.
Dr. Novais has also completed fellowships in musculoskeletal
oncology at the Mayo Clinic Department of Orthopedic Surgery in
Rochester, MN, and in adolescent and young adult hip-preservation
surgery at the Boston Children’s Hospital, Harvard Combined
Orthopedic Surgery. He was previously the director of the hip
program at the Children’s Hospital Colorado.

It is important to use the correct fixation method first: a) status
of elastic nailing after a secondary fall 10 days after placement,
b) submuscular plating 6 weeks after placement, c) successful
lateral trochanteric entry nail at 7 months after placement.

5

Foot fractures

Lab session

The difficulties in distinguishing between the normal variation of
the foot bones and fractures can lead to misinterpretation.
Mr. Monsell gave trainees the British view of open foot fractures,
and how to develop a multidisciplinary approach involving
mandatory attendance of both an orthopedic and a plastic surgeon.
The importance of acquiring a CT scan for displaced articular
fractures and the need to look proximally in a child with foot pain
were reinforced, as was being aware of deliberate injury in under
18 month olds with foot fractures.

Difficult surgical approaches to joints were the theme of the
hands-on session. Participants had the opportunity to work on
the anterior approach for hip drainage, lateral approach to the
hip, and triplane or tillaux approaches to the ankle. Participants
benefited from getting experience in some surgeries that may be
seldomly seen at their current level of clinical practice. Femoral
bridge plating was a very practical session, where each participant
was able to attempt screw placement, sometimes for the first time.
The tibial flexible nail training enabled students to learn from the
masters, taking home valuable tips for placement.

Open discussion: Vitamin D levels in
children with fractures
The day’s sessions closed with an open discussion on vitamin
D levels in children with fractures, particularly when there is
suspicion of metabolic fractures. The faculty were in agreement
that good-quality vitamin D studies are needed.

“It is unknown whether most children are
deficient or whether the “normal” vitamin
D levels are no longer appropriate.”
— A participant

Fergal Monsell, MB BCh, MSc, PhD
Christopher Iobst, MD
Director, Center of Limb Lengthening and
Reconstruction, Nationwide Children’s
Hospital, Columbus, OH
Dr. Iobst gained his medical degree from the
Emory University School of Medicine, following
which he undertook a residency at the Medical
University of South Carolina.
He went on to complete a fellowship in pediatric
orthopedics at the Boston Children’s Hospital.
Dr. Iobst’s specialty is in limb lengthening and
reconstruction.

6

Consultant Orthopaedic Surgeon, Bristol Royal Hospital
for Children, Bristol, UK
Clinical Senior Lecturer, University of Bristol, UK
Director, Avon Centre for Musculoskeletal Education
Mr. Monsell qualified in medicine from the Welsh National
School of Medicine, and completed further surgical training
at the University of Manchester, UK. He undertook
fellowship training at the Royal Alexandra Hospital for
Children in Sydney, Australia. He has been a consultant
orthopedic surgeon at a number of hospitals in the UK,
including the Hospital for Sick Children, Great Ormond
Street, and the National Orthopaedic Hospital in Stanmore.
Mr. Monsell has a special focus on limb deformities and
treating children with cerebral palsy.

1ST ANNUAL PEDIATRIC ORTHOPEDIC SURGICAL TECHNIQUES LAB

Hip Osteotomies / Deformity / Foot
Deformity analysis

Limb length discrepancy

Dr. Iobst led a speedy, interactive session on the principles of
deformity analysis, with the aid of an X-ray handed out at the start
of the session. After running through mechanical axis deviation and
joint orientation lines, and an explanation of the angles involved in
varus and valgus deformities, the students were able to identify the
deformities (which were both proximal and distal) on the example
X-ray.

Dr. Iobst gave a fast and informative session on leg-length
discrepancy, his area of expertise. Key points of interest in this area
of care:
• Some patients are bothered by small discrepancies, while
others are not bothered by large ones
• No treatment is necessarily required unless there is
documented regression or a functional problem
• If treatment is indicated, it is important to understand if
the discrepancy lies in the limb being too short or too long
compared with the contralateral limb
• Surgeons need to understand the anatomy of the physis,
knowing where and how to perform an epiphysiodesis to
achieve the desired results in case of a growing bone

“Consider the whole limb, and not just part of
the limb, as there is often more than one
deformity present.”
— Dr. Iobst
Hip osteotomies
Dr. Novais gave a video presentation on pelvic osteotomies,
focusing on the Bernese periacetabular osteotomy (PAO)
technique and the numerous structures that are at risk during each
of the cutting stages. Given the complicated nature of a PAO, it was
particularly beneficial for all participants to be able to practice this
complex surgical procedure in the lab.

Slipped capital femoral epicondilytis
(SCFE)/Hip dislocation
Dr. Kelly highlighted the importance of being able to know when an
endocrinopathy may be behind SCFE. “Knee pain in a child is a hip
problem unless otherwise diagnosed,” he said, stressing the need to
take appropriate steps to achieve the correct diagnosis:
• Image both hips
• Obtain both lateral and AP radiographs, as 14% of SCFEs
are missed on AP views
• Further imaging, including MRI, CT and bone scans can be
indicated in SCFE
Dr. Kelly then focused on the risk of future slips, the role of
prophylactic pinning and surgical techniques to treat SCFE,
including numerous reconstructive procedures. The fact that
SCFE treatment is a controversial topic, with many ways to treat
it, became the focus of the open discussion. SCFE treatment is
associated with steep learning curves, where the learning never
ends. Furthermore, as SCFE patients can be at risk of avascular
necrosis, timing is imperative.

“If you want to save the [femoral]
head, get out of bed,” and perform
early surgical intervention.

After cessation of growth, the options for limb lengthening include
the archaic-but-functional external fixator, the more modern
integrated fixator, or the intermedullary nail. Regardless of the
method, the surgeon should not forget to address the underlying
cause of the deformity and assess stability of joints and additional
deformities. Given that leg-lengthening procedures occur over a
number of years, patient and family selection to ensure maximal
compliance is key.

Clubfoot
Mr. Monsell relived the change in therapeutic approach that
occurred during his career with the advent of the Ponsetti
approach to casting. Although this casting technique has
revolutionized club foot treatment, surgeons should still be aware
of how to perform surgery in case of recurrence. The use of video
instruction on the Ponsetti technique before the hands-on casting
workshop enhanced the learning experience.

Lab session
The lab session enabled participants to be actively taught the
complex PAO technique by four expert PAO surgeons. Participants
were able to rotate to other lab stations to practice SCFE screw
placement, surgical hip dislocation and attempt a tibialis anterior
tendon transfer. During the casting workshop, surgeons imparted
their pearls of wisdom with regards to cast removal and molding.
One student said that after trying out casting and cast removal,
she felt confident enough to attempt cast removal on an infant, if
under supervision. The set-up of the lab session allowed for more
one-on-one teaching, especially beneficial for those interested in
specific techniques.

Dr. Edmonds reinforced the economic burden of sports-related
injuries and conditions in pediatrics, which exceeds $2.5 billion
in the U.S. per year. Children present numerous risk factors for
sports-related musculoskeletal injuries:
• Children have open growth plates and immature bones
• They often specialize early in specific sports and have
insufficient rest after injury
• Children often concurrently participate in multiple sports,
stressing different joints at the same time
• Particularly in contact sports, they may be unevenly
matched in size and strength

Because adult ACL reconstruction techniques put the physis at risk
— leading to iatrogenic growth disruption — participants learned
the specially developed pediatric techniques for physeal-sparing
reconstruction, including combined intra-articular and extraarticular reconstruction of the ACL with an iliotibial band graft. A
series of arthroscopic images accompanied the description, helping
illustrate the key points. Dr. Murnaghan then presented his take
on Dr. Allen Anderson’s published ACL reconstruction technique,
in which both femoral and tibial tunnels, and the fixation for the
quadruple hamstring graft are kept within the physis.
Dr. Murnaghan then reviewed closed treatment options for type

Aside from the economic cost, injury can lead to lowered
academic performance and depression, and increases the risk
for osteoarthritis and obesity. Educating patients and families to
avoid non-stop and simultaneous sport training, and promoting
awareness of healthy sports practices, is critical to helping pediatric
patients achieve life-long musculoskeletal health.

I and type II tibial spine fractures, mini-arthrotomy reductions in
cases where arthroscopic reduction is not possible, and the use of
screws and suture-fixation methods. The focus was on choosing
the right fixation method based on the fragment, and the right
technique based on the comfort level of the operating surgeon.

Pediatric knee injuries (discoid
meniscus, meniscus tears,
osteochondritis dissecans)
Dr. Murnaghan stressed the importance of correct imaging —
particularly the usefulness of coronal, sagittal and axial images on
MRI — for diagnosing symptomatic discoid meniscus. Regarding
treatment techniques, setting realistic expectations in discoid
meniscus repair is important, as it is difficult to achieve a perfect
knee. For osteochondritis dissecans (OCD), Dr. Murnaghan
reinforced that correct diagnosis and thorough assessment of the
lesion is important to determine the treatment:
• Obtaining tunnel and skyline radiographs in addition to
AP and lateral, and routinely using MRI allows for a better
estimate of the size of the lesions
• Juvenile OCD may be resolved non-operatively, with
drilling or fixation
• Non-operative treatment for adolescent OCD has limited
use and drilling none, leaving fixation and salvage with
augmentation as the treatment choice, dependent on
arthroscopic classification

Lucas Murnaghan, MD, MEd
Staff Physician in Orthopaedic Surgery, The
Hospital for Sick Children, Toronto, Canada
Assistant Professor, Department of Surgery,
University of Toronto, Toronto, Canada
Dr. Murnaghan graduated with a degree in medicine at Queen’s
University, Kingston, Ontario (2001), before completing his
orthopedic residency at The University of British Columbia,
followed by a fellowships in arthoscopy and athletic injuries.
He then went on to undertake pediatric fellowships at the Royal
Children’s Hospital in Melbourne, Australia, and at the Texas
Scottish Rite Hospital for Children in Dallas, TX. Dr. Murnaghan
focuses on pediatric and adolescent sports injuries, and is closely
associated with the University of Toronto and Women’s College
Hospital. Research interests:
• Apert syndrome
• Trauma
• Developmental dysplasia of the hip

8

1ST ANNUAL PEDIATRIC ORTHOPEDIC SURGICAL TECHNIQUES LAB

Patella femoral realignment
Patellar instability is the most common knee disorder in
children. Correct diagnosis is important, and surgeons should
gain experience in repair techniques. Dr. Milbrandt presented a
treatment algorithm for patellar instability and reviewed different
medial patellofemoral ligament (MPFL) reconstruction techniques,
which participants could then attempt in the subsequent lab
session.

Lab session
There were four knee stations, allowing intensive instruction
for participants keen to practice MPFL and physeal-sparing ACL
reconstructions using surgical instruments specifically designed for
this purpose.

Dr. Milbrandt graduated from the University of Virginia School of
Medicine (1997) and went on to complete fellowships in pediatric
orthopaedic surgery at the Texas Scottish Rite Hospital in Dallas.
He also gained a Master of Science from the University of Virginia
(2002). Clinical and research interests:
• Pediatric orthopedics — scoliosis, clubfeet, cerebral palsy,
trauma
• Tissue engineering
• Outcomes research
He served on the board of the American Academy of Orthopedic
Surgeons (AAOS) from 2013–2015, before which he was a chair,
candidate, resident and fellow subcommittee for the AAOS (2011–
2013). He served on the board of the Pediatric Orthopaedic Society
of North America (POSNA) from 2009–2011.

Osteotomy types
Dr. Fletcher provided participants with detailed insights into spinal
osteotomy types and a full understanding of their challenges,
including the inevitability of a steep learning curve, and the high
risk of complications with the rare and complex vertebral column
resection. Success is dependent on:
• Thorough training in Smith-Petersen and pedicle
subtraction osteotomies
• The support of an experienced surgeon
• The advice of a neurosurgeon
• Understanding and being competent in a variety of
techniques in case an intraoperative change in procedure
is required
The presentation stimulated valuable discussion on the positives
and pitfalls of osteotomy surgery.

Pedicle screws, sacral and selvic fixation
Dr. Sawyer covered the essential of spinal fixation in relation to
osteotomy. Surgeons must focus on expanding their skillsets and
gaining knowledge of multiple techniques; being able to place
pedicle screws, as well as hooks and wires in case of screw failure, is
important. Maintaining a rigorous knowledge of anatomy was also
encouraged.

Nicholas Fletcher, MD
Assistant Professor of Orthopedic Surgery, Emory
University School of Medicine, Atlanta, GA
Fellowship Director, Emory Pediatric Orthopedics
Co-director, Spine, Children’s Healthcare of Atlanta
Dr. Fletcher attained his medical degree at the
Vanderbilt University, Nashville, TN (2004) and
completed his orthopedic residency at the Vanderbilt
University Medical Center. After residency, Dr. Fletcher
undertook a fellowship in pediatric orthopedics at the
Texas Scottish Rite Hospital for Children in Dallas,
TX, and went on to join Emory University School of
Medicine (2010) as an orthopedic surgeon specializing
in pediatric conditions, with a special focus on spine and
hip conditions. He is a member of the Scoliosis Research
Society education committee. Research interests:
• Hip dysplasia
• Development of a minimally invasive approach
to surgical hip reconstruction
Dr. Fletcher Additionally, is an active educator,
overseeing the pediatric orthopedic education program
at the Emory University School of Medicine.

9

Correction strategies for adolescent
idiopathic scoliosis (AIS)

Growth-friendly surgery
Dr. Sawyer highlighted that this is a changing field with rapidly
advancing technology, and that early in situ fusion is associated
with poor pulmonary outcomes. For new surgeons, it is essential to
understand normal growth and spinal thoracic development, which
are not linear.
Treatment modalities for early-onset scoliosis included rib- and
spine-based therapies, such as Vertical Expandable Prosthetic
Titanium Rib (VEPTR), growing rods, magnetic-driven growth
rods, and tethers. Because treatment can last longer than 10
years, surgeons should be familiar with all techniques across the
continuum of a child’s care. Participants were also made aware of
the possibility of thoracic insufficiency syndrome in early-onset

Dr. Ritzman led the participants through a comprehensive overview
of correction strategies for adolescent idiopathic scoliosis and tips
for undertaking surgery:
• Rod strength is a factor in the success of surgery
• High-density implants with high stiffness, and precontoured rods are needed
The biomechanical benefits of ponte osteotomy for posterior
release were also touched upon, before Dr. Ritzman took the
participants through the rod rotation procedure with simultaneous
dual rods with differential rod contour, which gives safe and
gradual correction.

scoliosis. Dr. Sawyer closed by explaining the complexities of rod
passage, the advantages of using a chest tube to assist in passing,
and the need for awareness of intra-thoracic passage.

Lab session
Participants were able to learn and practice facetectomies, insert
pedicle screws, and attempt corrective derotation and reduction
techniques for AIS. The session included a demonstration of
magnetic growing rods. The participants did not shy away from
training in complex spine surgery, attempting some rare surgeries
in the safe setting of the bio-skills lab while under the watchful eye
of experienced surgeons.

Jeffrey Sawyer, MD

Surgical Tip 2: To avoid accidental damage to the chest
structures, make sure the tip of the hemostat is facing
upwards during chest tube placement for rod passage.

Dr. Sawyer received his medical degree from the University of Rochester in 1993. His
orthopedic residency was undertaken at the University of Pennsylvania hospital. He is a
member of the American Academy of Orthopedic Surgeons and Pediatric Orthopaedic
Society of North America, as well as the Scoliosis Research Society and American
Academy for Cerebral Palsy and Developmental Medicine. He currently serves on the
editorial board of the American Journal of Orthopedics.

“It was amazing to see the learning
happening — they are drinking
from the fountain of knowledge.”
— Dr. Milbrandt

11

Residents and fellows who attend the Annual Pediatric Orthopedic Surgical Techniques
Lab receive the full breadth of education: instruction and learning steeped in real-life
perspectives, and practical lab work that lets them gain hands-on experience.
But more than that, it’s all done in an atmosphere that allows for open discussion without
the classical hierarchy of teaching.

“Trainees benefit from the
fellowship of experience.”

— Dr. Ho

OrthoPediatrics was founded to focus exclusively on pediatric orthopedics, and is
committed to the cause of improving the lives of children with orthopedic conditions.
Education is one of the four pillars of OrthoPediatrics, and we’d like to invite you to expand
your surgical horizons at the 2nd Annual Pediatric Orthopedic Surgical Techniques Lab in
2017:
• Learn from experts who are innovative thought leaders, and phenomenal educators
•
•
•
•

in pediatric orthopedics
Perform a variety of procedures in a safe and supportive environment
Try out new techniques, and partake in rarer, more complicated operations
Ask your most pertinent questions in a more-relaxed, less-formal setting
Catch up with old colleagues, meet new peers and build lasting relationships for the
rest of your professional life

“Hands-on, interactive training makes a major contribution
toward educating a new generation of surgeons,
who are taking the torch from the old.”
And OrthoPediatrics’ dedication to education will continue for years to come.

OrthoPediatrics cordially invites
you to join us in 2017
Stay in touch: .
www.orthopediatrics.com .

12

1ST ANNUAL PEDIATRIC ORTHOPEDIC SURGICAL TECHNIQUES LAB

Note
This document is intended exclusively for experts in the
field, i.e. physicians in particular, and expressly not for
laypersons.
The information on the procedures contained in
this document is of a general nature and does not
represent medical advice or recommendations. Since
this information does not constitute any diagnostic or
therapeutic statement with regard to any individual
medical case, individual examination and advising of the
respective patient are absolutely necessary and are not
replaced by this document in whole or in part.
This document was commissioned by OrthoPediatrics.
The contents of this document are based upon
presentations given during the Pediatric Orthopedic
Surgical Techniques Lab in Memphis, Tennessee, USA,
on 30 September and 1 October, 2016. The statements
presented within this document are the opinions of the
presenters and may or may not represent the opinions of
OrthoPediatrics.
The information contained in this document was
gathered and compiled by medical experts and
OrthoPediatrics employees to the best of their
knowledge. The greatest care was taken to ensure the
accuracy and ease of understanding of the information
used and presented.
OrthoPediatrics does not assume any liability, however,
for the timeliness, accuracy, completeness or quality of
the information and excludes any liability for tangible or
intangible losses that may be caused by the use of this
information.

Colophon
This meeting report was written by Medicalwriters.
com LLC and commissioned by OrthoPediatrics. The
content of this report is based on the presentations given
during the Pediatric Orthopedic Surgical Techniques Lab
in Memphis, Tennessee, USA, on 30 September and 1
October, 2016.

Trademarks
OrthoPediatrics, ArmorLink, Jiminy, PediFlex, PediFrag,
PediLoc, PediNail, PediPlates, PLEO, RESPONSE, Scwire,
ShieldLoc, and the OP and Pedi logos are trademarks of
OrthoPediatrics Corp.
OrthoPediatrics is a registered trademark in the Brazil,
Colombia, S.Korea, and the U.S.A. Jiminy is a registered
trademark in the European Union and the U.S.A. PediLoc
and PediPlates are registered trademarks in Chile
and the U.S.A. The OP logo is a registered trademark
in Colombia, European Union, Japan, and the U.S.A.
The Pedi logo is a registered trademark in Argrentina,
Australia, Brazil, Chile, Colombia, European Union, Israel,
Mexico, New Zealand, S.Korea, Taiwan, Turkey, and the
U.S.A. Scwire is a registered trademark in the U.S.A.

Agency

This CME offering was Jointly Provided by Medical
Education Resources and BroadWater, LLC, and received
support from OrthoPediatrics, Inc.